Veterans may have experienced issues with scheduling appointments and receiving care in the past. These problems are being addressed by making it easier for Veterans to schedule community care appointments themselves, with the help of a VA staff member, or with the help of a third-party administrator (TPA). VA is also rolling out new technology that improves communication and coordination between Veterans, community providers, and VA employees.

While accessing community care will become easier in the future, it’s important to know that Veterans eligible for community care will generally still have the option to choose to receive care from a VA medical facility or community provider.

After a Veteran is determined to need treatment and found eligible for community care, he or she will generally have the option of choosing to receive care from a VA medical facility or community provider.

Finding a Community Provider

Community care is available from a broad range of community providers in VA’s network. VA’s network includes providers that participate in regional community care networks that are managed for VA by Third Party Administrators under contract with VA, as well as other community providers with whom VA contracts directly.

A VA staff member will discuss with an eligible Veteran who chooses to receive community care his or her preferences for getting care. For example, a Veteran may want to find a community provider that can see them sooner and is located near his or her home. Based on the discussion between the Veteran and the care team, VA will work with the Veteran to accommodate his or her preferences and select a community provider in VA’s network that’s currently available to provide that care.

Community providers in VA’s network can be found using VA’s Provider Locator, available from the following web address: https://www.va.gov/find-locations/. Note: Not all community providers in VA’s network and listed in VA’s Provider Locator will be available to provide community care, and VA might not be able to accommodate a Veteran’s preferences. If a Veteran expresses a preference for a specific community care provider in VA’s network, VA will determine if that provider is currently available to provide that care, and, if not, inform the Veteran and work with the Veteran to identify alternatives.

If none of the community providers in VA’s network are feasibly available, VA will work to add a provider to the network. If there is a specific community provider the Veteran would like to see that is not in VA’s network, VA may be able to add the provider to its network. However, this may take some time, and not all providers may want to be part of VA’s network. To see if it would be possible to add the provider to VA’s network, a VA staff member will work with the Veteran to find out more information about the specific community provider and determine next steps.

Referrals

VA will send a referral to the Veteran and to the selected community provider. VA will also send any pertinent medical documentation to the community provider to ensure proper care coordination.

The VA referral is important because it authorizes the Veteran to receive care from the community provider. Without the referral, VA has not authorized and cannot pay for the care in most circumstances.

Once a referral is sent to the Veteran and the selected community provider, an appointment can be scheduled.

Scheduling Appointments

Veterans have several options when it comes to scheduling an appointment with a community provider. Depending on the type of care a Veteran needs, a VA staff member will work with the Veteran to determine which options are available.

Veteran Directly Schedules Appointment – After a community care consult has been approved and a referral is sent to the selected provider, Veterans can directly contact the community provider in VA’s network to schedule an appointment. Afterwards, the Veteran provides the appointment information to a VA staff member as soon as possible in order to ensure tracking and continuity of care.

VA Staff Member Schedules Appointment – Veterans can provide their appointment preferences (such as the specific provider, location, date, and time of day) to a VA staff member. Based on the Veteran’s preferences and the community provider’s availability, a VA staff member will work to schedule the appointment.

VA TPA – In some cases for specific VA medical facilities, Veterans can provide their appointment preferences (such as the specific provider, location, date, and time of day) to a TPA. Based on the Veteran’s preferences and the community provider’s availability, the TPA will work to schedule the appointment.

Getting Care

When the Veteran arrives for the appointment, the community provider should have the appointment, VA referral, and pertinent medical documentation on file and be ready to see the Veteran.

Prescription Medication

VA will pay for or fill prescriptions written by community providers. For prescription medication longer than a 14-day supply, the prescription must be submitted to VA to be filled.

Note: As applicable, VA copayments apply for medication prescribed by a community provider.

Going Forward

The process and information above represents improvements to current practices rather than any major changes to how Veterans currently find a community provider, make an appointment, or receive community care. As VA continues to implement improvements to community care, Veterans can expect overall customer service to improve.

Author

VAntagePoint Contributor

— VAntage Point Contributors provide insight and perspective on a wide range of Veterans issues. If you’d like to contribute a story to VAntage Point, learn how you can submit a guest blog at http://www.blogs.va.gov/VAntage/how-to-submit-a-guest-post/

Comments

On June 21, 2019, I was contacted by the VA letting me know that I am approved for care in the community. I was told to wait for someone to contact me. No one has. I called back today, July 2, 2019, and was told me referral is approved and I just need to wait for the Mission Act person to call me.

At only 10 days past implementation, an appt was made with a Community Provider and I was called the next day by them with an appt for the next day. Wow! Seamless, no hassle experience. What a marvelous transparent experience. I love the VA! Thanks to all in organization.

I had approved dental care under the choice program. Because of the extensive dental work required, I was unable to do the work and we asked for an extension, as not enough time was allotted for the work to be completed before June 6. I was told that there was no longer availability of dental care once choice ended because of this new program. I’ve had a broken tooth since October and it took from November to April to get approval for the needed treatment, then not enough time to get the treatment done. When will dental be included so I can get this taken care of finally?

Not surprising, there are no community providers associated with my specialized health needs in Evansville, Indiana and the solution the VA arrived at for urgent care is to exclusively have the in house care at CVS pharmacies be their only contracted provider. Yeah, this is a pig in a poke, translation: The Mission Act is a joke!

That is the exact situation here in San Luis Obispo county California. What a complete joke. I recently read an article about the mismanagement of the past Choice Program which stated that for every referral that they provided they charged the VA $295. It just makes me sick. Yesterday, Sunday I needed to go to an urgent care clinic for a small issue, just needed some anti biotics for an infection. I thought the new Mission Act being newly implemented would help me out. Not so, all four urgent care cliniics in my area say that they do not accept VA people. The charge would have been $130 for that office visit. Simple one would think. Not with the VA boundoggle, they would rather generate a mass of paperwork and obsticles that give a veteran care. The VA needs to be dismantled.